Keratitis – infektiös oder autoimmun?

Zusammenfassung

Die Histopathologie ist ein wichtiger Baustein in der Differenzierung von Keratitiden in infektiöse und nicht infektiöse Entitäten. In beiden Keratitisformen treten Entzündungen, oft verbunden mit Nekrose und Keratolyse auf. Die histologische Untersuchung ist besonders bedeutsam in der Identifizierung von Erregern, der Diagnosestellung und/oder im Verlauf bei Herpes-simplex-Viruskeratitis, mykotischer Keratitis, Akanthamöbenkeratitis und Mikrosporienkeratokonjunktivitis. Wertvolle pathogenetische Hinweise mit therapeutischer Relevanz konnten histopathologische Studien liefern bei Nummuli nach Keratoconjunctivitis epidemica und atopischer Keratokonjunktivitis.

Abstract

Histopathological evaluation of ocular tissues is important in differentiating between infectious and autoimmune disease. Inflammation, necrosis and keratolysis are common to most forms of keratitis. Histopathology can be of great help in identifying the causative organism, establishing a final diagnosis and/or managing the patient with herpes simplex virus keratitis, mycotic keratitis, acanthamoeba keratitis or microsporidia keratoconjunctivitis. Important pathogenetic knowledge with therapeutic relevance has been gained from histopathological studies in nummular keratitis after epidemic keratoconjunctivitis and atopic keratoconjunctivitis.

Schlüsselwörter

Kornea - Mikrobiologie - Pathologie

Key words

cornea - microbiology - pathology

• Literatur

• 1 Kreger AS. Pathogenesis of Pseudomonas aeruginosa ocular diseases. Rev Infect Dis 1983; 5 (Suppl. 05) S931-S935
• 2 Messmer EM, Foster CS. Vasculitic peripheral ulcerative keratitis. Surv Ophthalmol 1999; 43: 379-396
• 3 Brasnu E, Bourcier T, Dupas B et al. In vivo confocal microscopy in fungal keratitis. Br J Ophthalmol 2007; 91: 588-591
• 4 Kanavi MR, Javadi M, Yazdani S et al. Sensitivity and specificity of confocal scan in the diagnosis of infectious keratitis. Cornea 2007; 26: 782-786
• 5 Hau SC, Dart JK, Vesaluoma M et al. Diagnostic accuracy of microbial keratitis with in vivo scanning laser confocal microscopy. Br J Ophthalmol 2010; 94: 982-987
• 6 Thomas PA. Current perspectives on ophthalmic mycoses. Clin Microbiol Rev 2003; 16: 730-797
• 7 Lund OE, Stefani FH. Corneal histology after epidemic keratoconjunctivitis. Arch Ophthal 1978; 96: 2085-2088
• 8 Dosso AA, Rungger-Brandle E. Clinical course of epidemic keratoconjunctivitis: evaluation by in vivo confocal microscopy. Cornea 2008; 27: 263-268
• 9 Mietz H, Cassinotti P, Siegl G et al. Detection of herpes simplex virus after penetrating keratoplasty by polymerase chain reaction: correlation of clinical and laboratory findings. Graefes Arch Clin Exp Ophthalmol 1995; 233: 714-716
• 10 Shimomura Y, Deai T, Fukuda M et al. Corneal buttons obtained from patients with HSK harbor high copy numbers of the HSV genome. Cornea 2007; 26: 190-193
• 11 Holbach LM, Font RL, Naumann GO. Herpes simplex stromal and endothelial keratitis. Granulomatous cell reactions at the level of Descemetʼs membrane, the stroma, and Bowmanʼs layer. Ophthalmology 1990; 97: 722-728
• 12 Mietz H, Font RL. Acanthamoeba keratitis with granulomatous reaction involving the stroma and anterior chamber. Arch Ophthal 1997; 115: 259-263
• 13 Michel R, Rohl R, Schneider H. [Isolation of free-living amoebae from nasal mucosa of healthy individuals]. Zentralbl Bakteriol Mikrobiol Hyg B 1982; 176: 155-159
• 14 Brindley N, Matin A, Khan NA. Acanthamoeba castellanii: high antibody prevalence in racially and ethnically diverse populations. Exp Parasitol 2009; 121: 254-256
• 15 Cursons RT, Brown TJ, Keys EA et al. Immunity to pathogenic free-living amoebae: role of humoral antibody. Infect Immun 1980; 29: 401-407
• 16 Radford CF, Minassian DC, Dart JK. Acanthamoeba keratitis in England and Wales: incidence, outcome, and risk factors. Br J Ophthalmol 2002; 86: 536-542
• 17 Pfister DR, Cameron JD, Krachmer JH et al. Confocal microscopy findings of Acanthamoeba keratitis. Am J Ophthalmol 1996; 121: 119-128
• 18 Lowder CY, Meisler DM, McMahon JT et al. Microsporidia infection of the cornea in a man seropositive for human immunodeficiency virus. Am J Ophthalmol 1990; 109: 242-244
• 19 Theng J, Chan C, Ling ML et al. Microsporidial keratoconjunctivitis in a healthy contact lens wearer without human immunodeficiency virus infection. Ophthalmology 2001; 108: 976-978
• 20 Chan CM, Theng JT, Li L et al. Microsporidial keratoconjunctivitis in healthy individuals: a case series. Ophthalmology 2003; 110: 1420-1425
• 21 Gottsch JD, Li Q, Ashraf F et al. Cytokine-induced calgranulin C expression in keratocytes. Clin Immunol 1999; 91: 34-40
• 22 Kafkala C, Choi J, Zafirakis P et al. Mooren ulcer: an immunopathologic study. Cornea 2006; 25: 667-673
• 23 Foster CS, Calonge M. Atopic keratoconjunctivitis. Ophthalmology 1990; 97: 992-1000
• 24 Messmer EM, May CA, Stefani FH et al. Toxic eosinophil granule protein deposition in corneal ulcerations and scars associated with atopic keratoconjunctivitis. Am J Ophthalmol 2002; 134: 816-821
• 25 Trocme SD, Gleich GJ, Kephart GM et al. Eosinophil granule major basic protein inhibition of corneal epithelial wound healing. Invest Ophthalmol Vis Sci 1994; 35: 3051-3056